Medicaid Reforms Will Harm People With HIV

May 28, 2012

Illinois General Assembly Enacts Medicaid Reforms That Are Likely to Harm People with HIV
Lawmakers Amend but do not Remove Medication Access Restrictions; Implementation Details Critical

SPRINGFIELD - On May 24, the Illinois General Assembly passed a sweeping package of changes to the Medicaid program.  Governor Pat Quinn is likely to sign the changes into law.

“The Medicaid changes approved yesterday will unquestionably harm people with HIV, working families, people with disabilities, and seniors.  We opposed many of the changes in the bill,” said David Ernesto Munar, President/CEO of the AIDS Foundation of Chicago (AFC).


Although deeper cuts were averted by passage of the new tobacco tax, which AFC supports, the General Assembly did not consider other options to find new revenue.  For example, Illinois cut taxes in 2011 for some of the state’s largest corporations, depriving the state of $157 million in tax revenue that could have done much to reduce the Medicaid deficit.

AFC is particularly concerned about two changes in the Medicaid bill and their impact on people living with HIV.  New restrictions to HIV medications provided by Medicaid could make it harder for people with HIV to receive the life-saving medications they need to stay healthy.  The restrictions would allow the state to institute changes to lower utilization of HIV medications. Thanks to language added at the request of AFC and partners, the state will be required to consult with HIV experts, providers and organizations to develop a cost-saving proposal.  Changes much yield the same cost saving as instituting prior approval.

“We thank the Quinn Administration and Representatives Greg Harris and Sara Feigenholtz, State Senator Heather Steans and other members of the General Assembly for championing language in the Medicaid bill that somewhat softens the blow of Medicaid medication changes for people with HIV,” said Ramon Gardenhire, Director of Government Relations for AFC.

“While we were not able to completely eliminate HIV medication controls,” continued Gardenhire, “the new language adds some flexibility and opportunity for input from providers, and recognizes the critical role adherence plays in controlling HIV costs.  We look forward to consulting with HIV health care experts, people with HIV, and the state to develop an implementation plan that will minimize the harm to people with HIV.”

Another concern is that the Medicaid bill eliminates IL Cares Rx, which helps several thousand people with HIV afford the cost of HIV medications obtained through the Medicare Part D prescription drug benefit.  All Illinois Cares Rx clients with HIV should apply immediately for the Illinois AIDS Drug Assistance Program, which will also cover these costs.  Illinois Cares Rx will end on June 30.

Finally, AFC praises the General Assembly for passing legislation that would allow Cook County to implement a proposed Medicaid 1115 waiver.  The waiver would expand Medicaid coverage to at least 100,000 low-income, uninsured Cook County residents, including people with HIV.

“The Cook County 1115 waiver will improve access to health care for uninsured, low-income people and stabilize the finances of the Cook County Health and Hospitals System,” said Gardenhire.  “It will bring more federal Medicaid revenue to Illinois without costing the state a dime.  It’s a win-win for patients and taxpayers.”

The Medicaid waiver has been a long time coming, Munar said.

“AFC has sought a Medicaid waiver to cover people with HIV for over a decade,” Munar noted.  “We are thrilled that Cook County Board President Toni Preckwinkle and Health and Hospitals System CEO Ram Raju have instituted this visionary change, and look forward to working with them to maximize the benefit for people with HIV without disrupting systems of care.  We urge the federal government to approve the waiver application immediately.”

Founded in 1985 by community activists and physicians, the AIDS Foundation of Chicago is a catalyst for local, national, and international action against HIV/AIDS.

Media contact:  John Peller, (312) 719-6208

Categorized under Health insurance.

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